Provider First Line Business Practice Location Address:
1313 21ST AVE S
Provider Second Line Business Practice Location Address:
VANDERBILT UNIVERSITY MEDICAL CENTER, 1103 OXFORD HOUSE
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-875-5838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2006